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 Fall 2006

Paramount’s Access Standards

Access is defined as the extent to which a member can obtain available medical services when he or she needs them. Below are the expected access standards for general medical and behavioral health services provided by Paramount physicians. If you are having problems obtaining these services, please call the Member Service Department at 1-419-887-2525 or 1-800-462-3589.

Medical

Behavioral Health

 
Type of Care RequiredStandard
Routine assessments, physicals or new visitsRoutine care/office follow-up visits: This type of care is generally for nonurgent, nonemergent assessments or visits; or posthospitalization visits for recurring problems when the member, Primary Care Physician and behavioral health provider agree with or prefer the scheduled time.Members can access care within 30 days.
Routine follow-up visits: for recurring problems related to chronic conditions such as hypertension, asthma or diabetesRoutine care/office visits: for new problems upon request of the member or provider

This type of care is generally for nonurgent, nonemergent assessments or visits; follow-up visits; posthospitalization and other visits for recurring problems.

Members can access care within 14 days.
Symptomatic nonurgent visits: for conditions such as a cold, sore throat, rash, muscle pain or headacheMembers can access care within two to four days.
Urgent medical problems: unexpected illnesses or injuries requiring medical attention soon after they appearUrgent care: may not be life-threatening but requires immediate attention (complex or dual problems such as substance abuse and mental problems)Members can access care within one to two days.
Serious emergencies: life-threatening illness or injury, such as heart attack, stroke, poisoning, loss of consciousness, inability to breathe, uncontrolled bleeding or convulsionsEmergency care: immediate threat to self or others (acutely suicidal or homicidal)

The expectation is that the patient will receive immediate emergency care; the mental health provider may either provide immediate care or direct the patient to call 911 or go to the nearest emergency room.

Immediate care
Access to care after hoursMembers will find access to after-hours care to be acceptable.
Return phone calls from provider office during office hoursMembers will find return phone calls during office hours to be acceptable.